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標題: | 麻醉中犬隻胃食道逆流之調查 The prevalence of gastroesophageal reflux in anesthetized dogs |
作者: | Yi-Hsuan Lin 林佚宣 |
指導教授: | 葉力森 |
關鍵字: | 犬,胃食道逆流,鹼性逆流, dog,gastroesophageal reflux,alkaline reflux, |
出版年 : | 2008 |
學位: | 碩士 |
摘要: | 一、 研究目的
本研究之目的為調查犬隻在全身麻醉下進行各式外科手術時之胃食道逆流 發生率,並分析影響逆流發生的危險因子 二、 研究程序 於台灣大學生農學院附設動物醫院外科,隨機收集100隻進行非消化道手術 外科程序及全身麻醉之犬隻的連續食道酸鹼值。所有的犬隻在手術前皆禁食12 至20個小時。若犬隻本身有慢性消化道或長期服用影響消化道運動相關的藥 物,皆不納入研究。 術前給藥由各麻醉師根據犬隻的生理狀況及手術程序來設計。所有的犬隻都 是用propofol作為導入麻醉,以isoflurane維持麻醉。在麻醉穩定後,由一名熟 悉食道酸鹼測量儀之人員將酸鹼探頭經口置入食道遠端之固定位置,測量食 道酸鹼值。所有的犬隻在麻醉中皆有完善的生理監控及紀錄。最後將所收集的資 料用統計方法分析,評估影響胃食道逆流相關之風險因子。 三、 結果 100隻狗中有35隻狗發生總共44次逆流。導入麻醉時Propofol的用量以及 麻醉時間的長短與胃食道逆流的風險呈現正相關,並有54%的逆流是發生在導入後20分鐘內。年齡、體重、品種、性別、胖瘦、ASA級別、手術的類型/姿勢、和術前給藥等與胃食道逆流之發生在統計上沒有顯著的關係。另外,在本研究中的鹼性逆流率遠高於過去其他犬隻的文獻,但在其中3隻發生鹼性逆流的狗的食道液體,只有一隻狗的bilirubin(代表有12指腸逆流)呈現陽性反應,其餘兩隻皆呈現陰性反應。 四、 結論 Propofol與胃食道逆流之發生有劑量效應(dose-dependent)。無論麻醉時間長 短都有胃食道逆流的風險,所以即使是短暫的麻醉,也不可忽略逆流重要性。過去認為是診斷胃食道逆流的黃金標準—食道酸檢測定,在鹼性逆流的認定標準上尚有瑕疵,未來可能還需要更多的研究來調整其定義。 Objective To investigate the incidence and risk factors of gastroesophageal reflux in anesthetized dogs undergoing various surgical procedures. Animals A total of 100 dogs, 6.9 ± 4.5 years old, weighing 10.8 ± 9.6 kg Methods The study group was dogs presenting to the National Taiwan University Veterinary Hospital for non-gastrointestinal procedures and surgeries requiring general anesthesia. Dogs with chronic gastrointestinal diseases or being persistently treated with drugs known to affect gastric motility/physiology and the tone of gastroesophageal sphincter were excluded. The premedication protocol was designed by anesthetists according to the physical status and the nature surgical procedure. All dogs were induced with propofol to achieve endotracheal intubation. Anesthesia was maintained with isoflurane in oxygen. Esophageal pH probe was placed during anesthesia. The gastroesophageal reflux was defined as the esophageal pH value under 4.0 or increasing above 7.5. Results Thirty-five dogs experienced gastroesophageal reflux during anesthesia, with a total of 44 episodes. The dosage of induction propofol and the duration of anesthesia had positive correlation with the risk of gastroesophageal reflux. The incidence of alkaline reflux was much higher than previously reported. In 3 episodes of alkaline reflux, only 1 showed bilirubin positive. Conclusions and Clinical relevance The risk of gastroesophageal reflux associating with induced propofol is dose-dependent. And all dogs have risk of reflux regardless of the length of anesthesia. Although measuring esophageal pH is the gold standard in diagnosing gastroesophageal reflux, esophageal secretion may contribute to false positive interpretation of alkaline reflux. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/37908 |
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顯示於系所單位: | 獸醫學系 |
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